Chocolate — NOT

Today, I had one of the toughest days at work that I have ever had. I am a psychiatric nurse.

For the first time, I had to put a patient in locked seclusion and another patient in physical restraints.

Ironically, both incidents involved addiction as well as mental illness, but for different reasons.

The first patient, right at the beginning of the shift, became physically and verbally aggressive, and unresponsive to redirection.

Why was he so angry? He wanted suboxone, a medication that is used for heroin withdrawal. When he couldn’t get it, he acted out. But, what was his reason for needing the suboxone? “I hear noises in my head. I am not in my right mind.”

Now, if you know anything about psychiatric medications, you know that suboxone is to ease narcotic withdrawal, but it is not an anti-psychotic. So, if you are hearing voices, suboxone is not the therapeutic drug of choice.

The second incident that occurred today truly breaks my heart, for all kinds of reasons.

This patient is an adult special needs child. She has intellectual challenges, and she is also very challenging on all sorts of other levels.

“My Little Sweetheart” seeks instant gratification; she is full of self-pity and consequently feels extremely entitled. In addition, she believes everyone else is responsible for her behavior. If she doesn’t get what she wants, if she is not spoken to in the way she wants, or is not given what she wants, when she wants it —- you made her act out. She HAD to speak and behave in the way that she did because of how YOU made HER feel. Does this sound familiar?

So being a compulsive overeater, I find there is a certain irony to the incident today. As I look at what was my first time putting a patient in restrains, I ask myself, “What was the final trigger?” The superficial answer is: Chocolate!

The patient’s grandmother came to visit her and gave her a chocolate bar. In a locked down acute psych unit, the patients are not allowed to have chocolate, only hard candy. Any food that is brought in may only be eaten during visiting hours.

Along came “My Little Sweetheart” who wanted to be able to eat her chocolate bar, even if it is against the rules. Naturally, as a terminally unique person, rules don’t apply TO HER.

When we went to get the chocolate bar, she not only refused to give it back. She quickly shoved as much of it as she possibly could into her mouth and refused to be redirected. Rather than give up the chocolate bar, she hit several staff members and finally required physical restraints to be applied for safety’s sake.

Subsequently, whenever we tried to remove the restraints, she would kick and scream, attempting to overturn the bed while she was still attached to it! One and a half hours later, when I concluded my shift, she was still kicking, screaming, and spitting on staff. She was completely unable to self-soothe or deescalate.

Of course, this entire incident wasn’t only about the chocolate bar. That was merely the icing on the cake. But, it reminded me: “Is it ever really just about the food???